Scheduling appointments in a healthcare setting is an exercise that ranges from very easy to very complex. In an ambulatory care clinic, appointments such as routine office visits and physician consults are relatively easy to schedule, but some patient visits require multiple providers and many different but related individual visits paneled together. Some specialty visits require lengthy procedures with heavily booked rooms and equipment, and there are many visits for which scheduling should not occur due to pregnancies or metallic implants, or drug interactions. In hospitals and specialty care facilities such as oncology and cardiology centers, the types of visits patients require may have very strict time, drug, and procedure requirements. Further complicating things is the fact that many providers, resources, rooms, or machines should not be scheduled for certain visits, or at certain times, etc.
In addition, due to the way that Medicare reimburses organizations, many facilities need to check procedures to determine whether they are medically necessary based on Local Medicare Review Policies (LMRP) and Correct Coding Initiative (CCI) warnings. These checks examine procedure-diagnosis pairings and multiple procedure orders to see whether they are authorized according to current guidelines.
But apart from the straightforward complexities of scheduling appointments, there is the importance of doing it properly, which is driven by the operational and billing protocols of each organization and by the risks associated with not providing appropriate patient care. Inappropriate visit type selection by schedulers can impact the care delivered to patients and can cause problems with resource availability in tightly booked and heavily scheduled environments. Furthermore, inappropriate visit type selection by schedulers can cause problems with collecting the right copays when the copays in a given benefit plan vary depending on the type of visit.
For all these reasons, it is incumbent upon schedulers to select the right visit types for patients. And it should be incumbent upon a healthcare information system's scheduling component to provide every possible aid to schedulers in selecting the right visit type.
Typical solutions to these problems have involved creating a catalog of available treatment types (which can number in the 100's or 1000's) from which the scheduler must make the correct selection. This often required some tools to be developed to aid the scheduler in that selection, such as naming or numbering schemes for the visit types, help files or on screen instructions. But quite often, it is acquired knowledge on the part of the scheduler that is his or her greatest aid.
There is a demonstrated need for a system that is able to provide flexible decision support for complex scheduling requirements to appointment schedulers at the point of visit type selection in a healthcare information system.